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Mar 19, 2012

Patients with relapsing onset multiple sclerosis (MS) who consumed alcohol, wine, coffee, and fish on a regular basis took 4 to 7 years longer to reach the point where they needed a walking aid than people who never consumed them. However the study, published in the April issue of the European Journal of Neurology, did not observe the same patterns in patients with progressive onset multiple sclerosis.

The authors say that the findings suggest that different mechanisms might be involved in how disability progresses in relapsing and progressive onset multiple sclerosis.

Researchers asked patients registered with the Flemish MS Society to take part in a survey, which included questions on themselves, their multiple sclerosis, and their current consumption of alcohol, wine, coffee, tea, fish, and cigarettes.

The 1372 patients who agreed to take part were also asked to indicate whether they had reached stage 6 on the 0 to 10 stage Expanded Disability Status Scale (EDSS) and, if so, when this had happened.

"MS is a chronic, often disabling disease that attacks the central nervous system" explains lead author Dr Marie D'hooghe from the National MS Center at Melsbroek, Belgium. "The clinical symptoms, progression of disability, and severity of MS are unpredictable and vary from one person to another.

"Two major MS onset types can be distinguished. Progressive onset MS is characterised by a gradual worsening of neurological function from the beginning, whereas patients with relapsing onset MS patients experience clearly defined attacks of worsening neurologic function with partial or full remission.

"EDSS 6 is an important milestone in the development of MS as it is the point at which patients need support to walk a reasonable distance."

The patients who took part were aged between 17 and 89 years-of-age:

• 65% (893) had relapsing onset multiple sclerosis. Seventy-six percent were female, with an average age of 50 years. Age at multiple sclerosis onset averaged 31.5 years and disease duration averaged 19 years.

• 35% (479) had progressive onset MS. Sixty-two percent were female, with an average age of 59 years. Age at multiple sclerosis onset averaged 37 years and disease duration averaged 21 years.

The researchers analysed how long it had taken people to reach EDSS 6 and compared those who reported moderate consumption of fish, alcoholic and non-alcoholic drinks, and cigarettes with those who reported occasional or no consumption. This showed that:

• Just over half (51%) had reached EDSS 6 after an average disease duration of 20 years. The percentage was much higher for people with progressive onset multiple sclerosis (80%) than relapsing onset (36%).

• Patients with relapsing onset multiple sclerosis who consumed moderate amounts of alcohol (1 drink a week or more) reached EDSS 6 seven years later than people who did not drink at all and wine drinkers reached it 4 years later than those who did not drink wine. The time differences were insignificant in people with progressive onset multiple sclerosis.

• Daily coffee consumption delayed reaching EDSS 6 by 5 years in people with relapsing onset multiple sclerosis, but there were no significant differences in people with progressive onset multiple sclerosis. Drinking tea daily produced insignificant results in both groups.

• People with relapsing onset multiple sclerosis who ate fish 2 or more times a week reached EDSS 6 seven years later than those who ate it less than once a month. It made no difference whether the fish was lean or fatty.

The time differences quoted above did not take into account gender, age at onset, and treatment, which are known to affect disability progression in multiple sclerosis. But even after adjusting for these factors, the hazard risk analysis for time to sustained EDSS 6 (where 1.0 was the reference number for 0 consumption) showed that:

• The only hazard risk of any statistical significance for progressive onset multiple sclerosis was 1.56 for patients who preferred fatty fish, compared with those who preferred lean fish.

The paper contains full details of the suggested mechanisms that may be involved in the links between consumption and disease progression.

"Although our findings show a number of associations between consumption and disease progression, it is important that patients recognise that this does not imply that certain food and drinks provide a protective effect as other factors may be involved" stresses Dr D'hooghe.

"Our study does, however, provide valuable pointers for future research as it reinforces the theory that different mechanisms may be involved in the progression of disability in relapsing and progressive onset MS."